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urbanvaughn15 I appreciate that. :) Sometimes I've felt negative about myself when advocating for patients. Like it was a bad thing. It's made me second guess myself as a nurse. I guess I have to find a balance between being too concerned about the patient and understanding the way healthcare works today-a lot of patients and not enough time. Sideshowstarlet-critical thinking is everything! I think this was the biggest thing I feel I havent learned in LTC. Its so task focused! It's hard to shut that mindset off sometimes :(

Lynker-WOW. Thanks so much for sharing this! Your honesty really helps me with my decision. I'm so sorry you had to go through all that. And I understand what you said about feeling you're the only one making it a big deal. That's happened to me in the past-everyone seemed so calm and it made me even more upset but I get it. It's funny now but not in the moment!! Thank you so much

These are all really really good responses! I'm going to take every single one into consideration. Thank you all sooo much

Also so there isn't any misunderstandings, I worked as a CNA for several years prior to working as an LPN. My goal is to learn how to work better as a team as opposed to telling others what to do (as technically thats what we are a team). I just feel like I need to be better at making sure tasks are being completed as well as they can be (within reason). I enjoy talking to the CNA's and learning about them so that they are comfortable with me. I also help out when I have the time because I remember how hard it was being a CNA. I do think you can't go wrong with educating yourself on a subject, including supervision. Thanks! :)

Hi again, everyone! I'm realizing I have been seriously lacking in my skills as a supervisor. I would like to grow in this area. I often supervise CNA's and although I haven't had many issues, I would like to be as professional as I can be. I'm currently an LPN transitioning into an RN role once I finish school. Are there any online courses or even books that anyone is aware of? Thanks!

sirl-thank you so much for your thorough response. I do feel that having a preceptor is a huge advantage. I believe my biggest concern is me realizing I've worked in LTC for so long but it's as though I don't know anything. I haven't been taught to critically think. How can you? It's a mountain of passing pills, trying to avoid falls and keeping your residents from eloping. I love learning and growing. I know that working LTC wasn't always by choice-as an LPN that's just the main option, unfortunately. (I did do some HH and that was better). In LTC I often found myself trying to protect my patients or advocate for them and was met with frustration by some of the other nurses. It seemed they just wanted to pass their pills and go home and I was being "over the top". Now I feel like all I learned was tasks and how am I going to succeed with this mindset?

Hello everyone, I'm currently an LPN. Although I do have some experience in SNF and LTC (mostly LTC), I haven't worked in this capacity for several years now. My last job years was at a clinic. I have not been working in general for over a year. I'm still trying to medicate for ADHD-inattentive type. The meds either didn't work or caused palpitations. I've been offered a Med-Surg position at a local hospital (apparently not the best company). I've considered the job mostly because of the smaller nurse to patient ratio. I've seriously struggled at SNF's/LTC before with time management. I felt like I could never catch up and like a horrible nurse. Others would say I was a great nurse, but honestly I think working so long in LTC made me feel like that was not the case. I realized I've never gotten more than 3 days in training and I feel this set me up to fail as well. The hospital intrigued me since they offer 8-16 weeks of training. My concern is the acuity is obviously higher, and I already do not feel confident. It's a night shift position so I'm not sure if that would be of help. On one hand, I'm worried I wouldn't be able to succeed in Med/surg, on the other hand I feel working LTC has eroded my self confidence (along with untreated ADHD). I need to decide today or tomorrow what position to take. I really care about my patients and want to be the best nurse I can be for them. I'm also about to start RN school in several months. Would it be unsafe for me to seriously consider the Med-Surg position? Thanks

Hi all, I have an interview with a great company but I am very very nervous-I have been an LPN for 5 years (mostly ltc but have also worked hospice as well). I'm currently in school and am leaving my current job because I was told it was part time but it really isnt. I loved the job but with school it was too much. Anyway, the agency knows i'm in school and is known for working around your schedule. I also have several good friends who work for them and love it. My question is-shouldn't field supervisors be RN's? I just can't see how I could 'train' an RN on the field. It should be the other way around! Has anyone here worked a position like this as an LPN or know of someone who has?? Thanks!!!

Thanks! I got my review today and it went excellent so at least I'm ok there. I still have so much to learn but learning is one of my favorite things to do. They are sending me to a 3 week wound course (once a week for 8 hours a day). I'm an LPN but the Rn's there have taken it and they all say how much I'm going to learn and that I will love it. It is a stressing job, plus state is coming any day now but honestly I'm just going to do the best i can and try to improve day by day. Its all I can do. I had one nurse try to freak me out about state, I responded that yes I should be worried LOL (I just started and am fixing things left and right) but im not going to lose it either. It is what it is. Hopefully that goes well...

Thank you both for the great suggestions!! Tammy you are so right-today when i went in i put my foot down and pulled the aides to the side and explained that the nurses are responsible for x,y and z. I also spoke to the shower aides so that we could have better communication. My DON agreed an inservice is in order for the nurses-theres no way i can look at every little thing and be expected to leave in 5 hours, plus do all the wounds.I like the idea of a documenting wound requests. Loo17 wow i could only dream of such organization hahahaha. that sounds amazing! The facility i work at is a pretty good one, but they have a big problem with call off's, which throws everything off. Today went alot better but it could be improved.

Getting really desperate for suggestions. If I continue getting out this late it's going to start affecting my schooling. I talked to my DON about me getting stuck with the skin tears, etc. which i shouldnt be doing. I had one very experienced RN tell me to look under a patients breast bc she had bleeding (like 2 drops!) and asked me to discontinue an ointment she was on. Then on my way out i had ANOTHER ask me to look at a patient "whose bottom is red but blanchable." I was like, uh....how about i NOT look and suggest some calmoseptime cream, better personal care and keeping her off her bottom?? Its getting really frustrating

Hi I just started a new part time wound care position (more info is in previous threads). Anyway, i have some wc experience, but I'm finding that I'm scheduled 5 hour days/6 days a week but im clocking out 2-3 hours after that I do all the wounds for a 120 bed facility, am responsible for updating orders/treatments, wound rounds with the physician, initiating orders, and of course get pulled left and right for new wounds. I enjoy my job and don't want to cut corners on performing the actual treatments. The issue I'm having is showers. I get the list daily and wait until after their shower to do treatments, but it's either the patient i need is in the shower, or they're in the dining room, or therapy....errr! I end up running in circles or popping in to find my patient 2-3 times. I know how huge a waste of time this is. I'm supposed to be out by 11:30 am. Does anyone have any suggestions on how to be more time efficient? Also I've noticed aides stop me to "look at something" often instead of finding their nurse first, and then calling me if needed. I asked them to please not do this and i got the evil eye LOL Any help???? Thanks!

Hello I'm going to try this again :)... I recently posted a thread about accepting a wound care nurse position at a SNF. I have what I call a small amount of experience (wound care on the weekends and of course wound care while working the floor). I don't think I do so great but I tend to get a lot of positive feedback from other nurses so I'm going to do everything I can to learn as much as possible. I went ahead and found Acute and Chronic Wounds : Current Management and Concepts 3rd edition for 6 bucks online (oh yeah!) and have been studying it practically non-stop. (I don't have the money to get certified yet-for those of you who are, I think you're amazing). Anyway, aside from that I've found some interactive online wound education sources as well. What i would like to know, is when you started (we were all there one day lol) what helped you the most as far as learning what worked best for what sort of wound, rounding with the wound care physician,etc. I know that books can only take me so far, and hands on experience is what will teach me the most. But I want to be as well prepared as possible. I've also been looking at you tube videos, etc. Thanks!

Hi everyone-I am an LPN who currently works at a SNF. I have several years of experience in LTC working the floor, and around 1 year accumulated experience of doing wound care on the weekends. I was offered the mon-fri wound care position at my current job (yay!). I was told its part time, 5 hours/day, which is great because I'm currently in school anyway. When asked about my responsibilities/job description, I was told I would be doing the wound care (obviously), doing rounds once a week with the WC physician and measuring, and changing/updating orders for treatments as needed. And that's pretty much it. I asked about documentation and they have an RN who does the MDS, the wound documentation, etc. Although it was not mentioned, I'm assuming patient/family education will be done by myself as well. So..I'm sitting here very happy but also confused. It seems like there HAS to be more to it than that, no? NOT that I'm complaining LOL but is that typical of an LPNs job description in this field? Or is there something they are not telling me... Thanks in advance for any information!

Hi I was recently hired at an ALF which requires for me to do alot of monthly MARS/TARS checks...the problem is I have never done it and have no clue how to. The last facility I worked at had specific nurses come in monthly to do those and i never learned. Can someone explain to me the process?? I would be beyond grateful!!!

hello again thanks so much for your responses! i completed my 2nd day and it went alot smoother then the first. I was better organized and made sure to stop as soon as i finished my first med pass to complete my charting, as well as soon as finished my last med pass. It was still crazy, but somehow i felt alot less intimidated and anxious-maybe bc i knew what i was getting into this time! lol

oh and golflinda-the answer to your question about my patient. No I've never done suctioning before so I wanted to watch someone do it. And to tell you the truth-most of the things i did that day I've never done before. So I guess the combination of a new job, so many things to do, new unfamiliar patients and learning all these new things at once was just overwhelming. But I know that one i get my organizational skills down it will be much better.

thanks for all your quick responses. When I did my orientation i was lucky enough to have very helpful nurses every time ( i had a different floor every day during my 3 day orientation) I knew there was no way they can show me everything-thats impossible. I read that ltc's tend to 'throw you to the wolves' and man was that right! lol I made myself a cheat sheet already so that my next shift wont be as hectic. Although it was insane, I learned alot in that one day.

After 3 days of orientation, I started on my own as an LPN at a skilled nursing facility. My patient load consists of about 30 residents and these include lots of g-tubes, tube feedings, accu checks and of course lots of meds! I work a 7a to 7p shift and I cant believe how crazy it is from 7-3. Being my first day, of course i was beyond overwhelmed. I learned how to give meds via g-tubes in orientation, but tube feedings and iv meds i had to learn my first day on my own. I was lucky enough to have a very nice nurse on my floor to help me, but i knew she was busy herself so I was worried about asking her too many questions. The most frustrating thing about the day was not being able to find alot of the patients meds. I wasted alot of time searching for medications that I just never found. I assume most of these meds are being borrowed from other residents, but because I'm not familiar with what each resident gets, I couldnt go through the entire med cart looking for each med that was missing. I ended up not giving at least 13 medications on my one shift because of this. Of course I had a patient who fell, 2 patients who couldnt breath, 2 patients who would not stop calling me in their room and a family member who was complaining about the CNA. I had a hospice patient that needed to be suctioned, and I've never done this before so I asked for help. Long story short, I had 4 other nurses trying to suction this patient and they couldnt figure out why the machine wasnt suctioning. We finally got another machine, and that one didnt suction either. After almost 30 minutes of this, I ended up leaving the other 4 nurses to suction this patient because it was 2pm and I still wasnt done with my 9am meds!! In the end I ended up leaving at almost 9pm and I couldnt even do my charting bc I was worried about getting in trouble with overtime since I am new. Is this the norm? I mean, I know its hard in the beginning but how long did it take you to become adjusted and HOW did you do it?? How do you organize your feedings and accu checks so that you dont waste so much time? And how do I tell the CNA's to please not chit chat with me at my med cart so I can actually do my job?

thanks for all the advice everyone :) i didnt really think about the fact that a bad ltc facility could put my license in jeopardy. kinda scary! i will keep everyone posted on whatever i choose

ive done some prereq's for my RN but wanted to be an LPN for 1-2 more years in order to feel more experienced. I didnt want to jump in and be an RN with more responsibility and not know what I was doing LOL. But I think youre right-I feel really limited as far as where I can work with my LPN license sometimes. Its hard to find a job, and I'm starting to wonder if its harder to find a DECENT job. It seems that I dont have the best instinct as far as jobs that I pick. I seem to end up in places that wont pay you when theyre supposed to or places that no one wants to stay at.

I recently was hired at a LTC facility working 12 hour shifts. I've been a nurse only a year and most of my experience is from working at a methadone clinic. I just started my new job but have seen that noone seems to stay there, people are constantly quitting or getting fired left and right. I was told by another orientee that when she went to get her background check they told her "this company has so many background checks being done that we cant handle them all. From now on they will have to wait 5 days in order to get the results". I've been wanting to work in LTC in order to get some sort of 'real' experience. I feel that I havent learned absolutely anything and that if I dont get good experience then I will have a hard time finding jobs in the future. The issue is that now I recieved a call from a weight loss center who want to interview me. I want to stay at the LTC job for experience, but now Im a litte reluctant to stay do to the crazy turn over rate. But I also am worried that if I take the weight loss clinic job (which hasnt even been offered to me but im thinking ahead just in case) that I wont learn very much there. I also know that I am very lucky to even have a job so I dont want to seem ungrateful. I'm not sure what to do. Has any LPN out there worked at a clinic like this? Did you learn alot? Thank you so much for any advice that you have.

i agree with kakamegamma-i in no way see how the op intentionally meant to be negative towards anyone. i think she would just like to know how to incorporate faith into her practice. I've thought about this once myself. Religion asks us to be patient, kind, respectfull and loving of all people-even on our worst, craziest days. If anything i think its harder to be a nurse who's trying to use her faith while at work. I can tell you that i wanna knock someone out almost every shift! lol But of course when I incorporate what Ive learned with my religion, it forces me to be kinder and more patient :)

wow im reading this post and its like i was the one that wrote it! Now i know im not the only one who has problems like this. I have a similiar situation at work, where no matter what I do, I'm constantly being bossed around and just treated like a total idiot. And if i say something to defend myself, they get really offended and then it turns into me being the bad guy. Sometimes i try to tell myself tht I should just let them say what the want and ignore it, but i know that that will end up with me blowing up down the road and things getting really ugly. I dont know how to handle people like this either

yea i was thinking the same thing. It seems that everyone is hiring PRN now, too. But I also dont want to take a chance and have it blow up in my face. Eventually I will find something full time.